Use the following Case Scenario, Subjective Data, and Objective Data to answer the Critical Thinking Questions.  Case Scenario  Mrs. J. is a 63-year-old woman who has a history of hypertension, chronic heart failure, and sleep apnea. She has been smoking two packs of cigarettes a day for 40 years and has refused to quit. Three days ago, she had an onset of flu with fever, pharyngitis, and malaise. She has not taken her antihypertensive medications or her medications to control her heart failure for 4 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure.  Subjective Data 1.Is very anxious and asks whether she is going to die. 2.Denies pain but says she feels like she cannot get enough air. 3.Says her heart feels like it is “running away.” 4.Reports that she is so exhausted she cannot eat or drink by herself.  Objective Data 1.Height 175 cm; Weight 95.5 kg 2.Vital signs: T 37.6 C, HR 118 and irregular, RR 34, BP 90/58 3.Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint; all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation 4.Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82% 5.Gastrointestinal: BS present: hepatomegaly 4 cm below costal margin  Critical Thinking Questions  What nursing interventions are appropriate for Mrs. J. at the time of her admission? Drug therapy is started for Mrs. J. to control her symptoms. What is the rationale for the administration of each of the following medications? 1.IV furosemide (Lasix) 2.Enalapril (Vasotec) 3.Metoprolol (Lopressor) 4.IV morphine sulphate (Morphine)  Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.  Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide rationale for each of the interventions you recommend.

Clearly, diagnosis is a critical aspect of healthcare. However, the ultimate purpose of a diagnosis is the development and application of a series of treatments or protocols. Isolated recognition of a health issue does little to resolve it.

In this module’s Discussion, you applied the Clark Healthy Workplace Inventory to diagnose potential problems with the civility of your organization. In this Portfolio Assignment, you will continue to analyze the results and apply published research to the development of a proposed treatment for any issues uncovered by the assessment.

To Prepare:

• Review the Resources and examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015).
• Review the Work Environment Assessment Template.
• Reflect on the output of your Discussion post regarding your evaluation of workplace civility and the feedback received from colleagues.
• Select and review one or more of the following articles found in the Resources:  
  • Clark, Olender, Cardoni, and Kenski (2011)
  • Clark (2018)
  • Clark (2015)
  • Griffin and Clark (2014)

The Assignment (3-6 pages total):

Part 1: Work Environment Assessment (1-2 pages)

• Review the Work Environment Assessment Template you completed for this Module’s Discussion.
• Describe the results of the Work Environment Assessment you completed on your workplace.
• Identify two things that surprised you about the results and one idea you believed prior to conducting the Assessment that was confirmed. 
• Explain what the results of the Assessment suggest about the health and civility of your workplace.

Part 2: Reviewing the Literature (1-2 pages)

• Briefly describe the theory or concept presented in the article(s) you selected. 
• Explain how the theory or concept presented in the article(s) relates to the results of your Work Environment Assessment.
• Explain how your organization could apply the theory highlighted in your selected article(s) to improve organizational health and/or create stronger work teams. Be specific and provide examples.

Part 3: Evidence-Based Strategies to Create High-Performance Interprofessional Teams (1–2 pages)

• Recommend at least two strategies, supported in the literature, that can be implemented to address any shortcomings revealed in your Work Environment Assessment. 
• Recommend at least two strategies that can be implemented to bolster successful practices revealed in your Work Environment Assessment. 

Work Environment Assessment- this is my discussion

Using the Clark Healthy Workplace Inventory (Clark, 2015) my workplace ranks 90, or very healthy.  Why it ranks as healthy or civil is that between units of the hospital there is great communication between units, to the extent that is a need on one unit as far as staffing, another unit will offer to help, this is the norm, and not the exception for our hospital. We also feel supported by management during times of crisis, I work in two distinct areas where things can escalate very quickly, both in inpatient psych, and Children pavilion for adolescent psych patients. We know we will always get backup from other building staff and security if things get escalated where there is danger to patients or staff. 

            Success in an organization comes from hardworking people who have a strong mission and vision with great strategies in place. This depends greatly on the leadership, management, and the team. To put things in perspective, the introduction of the workplace health status would give a broader picture. To be discussed below is a brief description of the results of the Work Environment Assessment at Chicago Lakeshore Hospital and based on the results, the explanation of how civil is this place with the reasons behind the claim. Also, this discussion includes a description of a situation where incivility in the workplace has happened and how was it addressed.

Workplace health is the status of the workplace concerning the workers, how civil is the place, and the overall environment safety for the employees. Lack of civility at the workplace contributes to poor employees’ job satisfaction, lack of courtesy and respect among peers, and it leads to poor patient outcomes (Tips to Improve Civility in the Workplace, 2017). Incivility at workplaces has the potential to emotional and physical distress to the workers and that can cause poor quality care and patient outcomes (Armstrong, 2017). To assess the civility of the workplaces, researchers have discovered tools to help assess the workplaces and the Work Environment Assessment is one of the tools. 

Using the Work Environment Assessment tool to assess Chicago Lakeshore Hospital revealed 90 which is a moderately healthy place. This means, in this organization, people live by the shared mission and vision, there is trust and respect among the workers, and communication at all levels is clear (Clark Healthy Workplace Inventory – americannursetoday.com. [n.d.]). The result assures the presence of teamwork and high levels of employees’ satisfaction. The workload is distributed equal and the organization offers competitive salaries. Based on my hospital workplace assessment results, the majority of the employees would recommend the place as a good place to work and overall there are high levels of employee satisfaction, therefore better outcomes (Clark Healthy Workplace Inventory – americannursetoday.com. [n.d.]).

Incivility incident at the workplace

          Courtesy and respect are not only meant for people of a certain rank within the organizations. These basic values and others are for everyone. Clark (2017), emphasizes all nurses have the obligation to foster healthy workplaces with an atmosphere of dignity, professionalism, and respect. Unfortunately, studies reveal incivility at workplaces, bullying, and lack of mutual respect (Armstrong, 2017). Incivility at the workplace has been linked to poor performance which impacts patient safety and the quality of patient outcomes (Armstrong, 2017). Marshall and Broome (2017) state that “workplace violence, incivility, and bullying are barriers to developing safe environments for providers and can occur in any setting” (p.261). The American Nurses Association (ANA; n.d.) defines incivility as “one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them” (para.2).  This brings back the memory of my former workplace. Doctors were very much valued and respected, but the nurses did not receive the same respect from the doctors. At times, nurses were hesitant to call the doctors for notification of patient condition change simply because of the fear of the expected response. There was no mutual respect. I am not sure how did this problem resolve after leaving the place but a few years down, the hospital was sold out to another company.

Conclusion

Civility at the workplace is not only important for the workers’ feelings it also influences overall performance, productivity, and patient outcomes. The consequences of incivility at workplaces “can result in life-threatening mistakes, preventable complications, and harm or even death of a patient” (Clark, 2017). It is with that intensity that the workplace health assessment should be one of our priorities. Despite the individual differences, we must find a way to improve civility at our workplaces. The first step towards improvement is to assess the current status and the Work Environment Assessment is a great tool.

References

Armstrong, N. E. (2017). A Quality Improvement Project Measuring the Effect of an Evidence-

Based Civility Training Program on Nursing Workplace Incivility in a Rural Hospital Using Quantitative Methods. Online Journal of Rural Nursing & Health Care, 17(1), 100–137. https://doi-org.ezp.waldenulibrary.org/10.14574/ojrnhc.v17i1.438

Clark, C. M. (2017). An Evidence-Based Approach to Integrate Civility, Professionalism, and 

Ethical Practice Into Nursing Curricula. NURSE EDUCATOR, 42(3), 120–126. https://doi-org.ezp.waldenulibrary.org/10.1097/NNE.0000000000000331

Clark Healthy Workplace Inventory – americannursetoday.com. (n.d.). Retrieved from 

https://americannursetoday.com/wp-content/uploads/2015/11/Clark-Healthy-Workplace-Inventory.pdf.

Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New Tork, NY: Springer.

Tips to Improve Civility in the Workplace. (2017). AACN Bold Voices, (1), 18. Retrieved from 

https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edsovi&AN=edsovi.01436852.201701000.00025&site=eds-live&scope=site

Rubric:

               

Part 1: Work Environment Assessment

·  Complete the Work Environment Assessment Template.
·   Describe the results of the Work Environment Assessment you completed on your workplace.
·   Identify two things that surprised you about the results and one idea that you believed prior to conducting the assessment that was confirmed.
·   Explain what the results of the assessment suggests about the health and civility of your workplace.
–Levels of Achievement:Excellent 45 (45%) – 50 (50%)
An accurate, detailed, and completed Work Environment Assessment Template is provided.

The responses accurately and thoroughly describe in detail the results of the Work Environment Assessment completed on a workplace.

The responses accurately and clearly identify two surprising things about the results and thoroughly describe in detail at least one idea that was believed prior to conducting the assessment that was confirmed.

The responses accurately and thoroughly explain in detail what the results of the assessment suggests about the health and civility of a workplace.
Good 40 (40%) – 44 (44%)
An accurate and completed Work Environment Assessment Template is provided.

The responses accurately describe the results of the Work Environment Assessment completed on a workplace.

The responses accurately identify two surprising things about the results and describe at least one idea that was believed prior to conducting the assessment that was confirmed.

The responses accurately explain what the results of the assessment suggests about the health and civility of a workplace.
Fair 35 (35%) – 39 (39%)
A completed Work Environment Assessment Template that is vague or inaccurate is provided.

The responses describe the results of the Work Environment Assessment completed on a workplace that is vague or inaccurate.

The responses identify two surprising things about the results and describe at least one idea that was believed prior to conducting the assessment that was confirmed that is vague or inaccurate.

The responses explain what the results of the assessment suggests about the health and civility of a workplace that is vague or inaccurate.
Poor 0 (0%) – 34 (34%)
A vague and inaccurate Work Environment Assessment Template is provided, or is missing.

The responses describe the results of the Work Environment Assessment completed on a workplace that is vague and inaccurate, or is missing.

The responses identify two surprising things about the results and describe at least one idea that was believed prior to conducting the assessment that was confirmed that is vague and inaccurate, or is missing.

The responses explain what the results of the assessment suggest about the health and civility of a workplace that is vague and inaccurate, or is missing.Feedback:

Part 2: Reviewing the Literature

·   Briefly describe the theory or concept presented in the article you selected.
·   Explain how the theory or concept presented in the article relates to the results of your Work Environment Assessment.
·   Explain how your organization could apply the theory highlighted in your selected article to improve organizational health and/or stronger work teams. Be specific and provide examples.–Levels of Achievement:Excellent 14 (14%) – 15 (15%)
The responses accurately and thoroughly describe the theory or concept presented in the article selected.

The responses accurately and completely explain in detail how the theory or concept presented in the article relates to the results of the Work Environment Assessment.

The responses accurately and thoroughly explain in detail how an organization could apply the theory highlighted in the selected article to improve organizational health and/or stronger work teams.  

Specific and detailed examples are provided which fully support the responses.
Good 12 (12%) – 13 (13%)
The responses accurately describe the theory or concept presented in the article selected.

The responses accurately explain how the theory or concept presented in the article relates to the results of the Work Environment Assessment.

The responses accurately explain how an organization could apply the theory highlighted in the selected article to improve organizational health and/or stronger work teams.  

Specific examples are provided which may support the responses.
Fair 11 (11%) – 11 (11%)
The responses describe the theory or concept presented in the article selected that is vague or inaccurate.

The responses explain how the theory or concept presented in the article relates to the results of the Work Environment Assessment that is vague or inaccurate.

The responses explain how an organization could apply the theory highlighted in the selected article to improve organizational health and/or create stronger work teams that is vague or inaccurate.

Vague or inaccurate examples are provided which may support the responses.
Poor 0 (0%) – 10 (10%)
The responses describe the theory or concept presented in the article selected that is vague and inaccurate, or is missing.

The responses explain how the theory or concept presented in the article relates to the results of the Work Environment Assessment that is vague and inaccurate, or is missing.

The responses explain how an organization could apply the theory highlighted in the selected article to improve organizational health and/or create stronger work teams that is vague and inaccurate, or is missing.

Specific examples are not provided to support the responses.Feedback:

Part 3: Evidence-Based Strategies to Create High-Performance Interprofessional Teams

·   Recommend at least two strategies, supported in the literature, that can be implemented to address any shortcomings revealed in your Work Environment Assessment.
·   Recommend at least two strategies that can be implemented to bolster successful practices revealed in your Work Environment Assessment.–Levels of Achievement:Excellent 18 (18%) – 20 (20%)
The responses clearly and thoroughly recommend in detail at least two strategies that can be implemented to address any shortcomings revealed in the Work Environment Assessment.

The responses clearly and thoroughly recommend in detail at least two strategies that can be implemented to bolster successful practices revealed in the Work Environment Assessment.
Good 16 (16%) – 19 (19%)
The responses accurately recommend at least two strategies that can be implemented to address any shortcomings revealed in the Work Environment Assessment.

The responses accurately recommend at least two strategies that can be implemented to bolster successful practices revealed in the Work Environment Assessment.
Fair 14 (14%) – 15 (15%)
The responses recommend at least two strategies that can be implemented to address any shortcomings revealed in the Work Environment Assessment that is vague or inaccurate, or only recommends one strategy.

The responses recommend at least two strategies that can be implemented to bolster successful practices revealed in the Work Environment Assessment that is vague or inaccurate, or only recommends one strategy.
Poor 0 (0%) – 13 (13%)
The responses recommend at least two strategies that can be implemented to address any shortcomings revealed in the Work Environment Assessment that is vague and inaccurate, only recommends one strategy, or is missing.

The responses recommend at least two strategies that can be implemented to bolster successful practices revealed in the Work Environment Assessment that is vague and inaccurate, only recommends one strategy, or is missing.Feedback:

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.
Good 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.     

Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.      

Purpose, introduction, and conclusion of the assignment is vague or off topic.
Poor 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion was provided.Feedback:

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Good 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
Poor 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.Feedback:

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
Good 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
Fair 3.5 (3.5%) – 3.5 (3.5%)

 The death of an elderly individual may occur in a variety of settings and circumstances. For example, an individual may die painlessly at home surrounded by the support of many loved ones, or an individual may suffer severe pain for months before dying in a health facility with little social support. In addition, it is possible that many health and helping professionals may interact with the dying person and his or her family.

For this Assignment, you consider a social worker’s role in end-of-life care. In addition to reading this week’s resources, conduct your own research and obtain at least one additional journal article that addresses how a social worker might support clients as they plan end-of-life care.

By Day 7

Submit a 2- to 4-page paper that analyzes the role of the social worker in helping to plan end-of-life care. Include possible consideration of palliative care, euthanasia, hospice care, the living will and advanced directives, and other factors. Research and cite at least one journal article to support your analysis.

“i need it within 8 hours or ASAP”

 A strain gauge is the circuit of choice for most pressure transducers. This is especially true for blood pressure transducers. Give a brief explanation of this technology, how they are used to obtain blood pressure readings, and four things to consider when examining readings from these transducers.